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Evaluation and Investigation of Pituitary Disease
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
In a minority of patients, pituitary apoplexy can be the first presentation of a pituitary adenoma. The classical presentation is severe, sudden headache and acute visual field deficit. The patient may present with a triphasic abnormality of ADH secretion: initially, diabetes insipidus, followed by a period of a syndrome of inappropriate ADH secretion (SIADH), followed by a return of diabetes insipidus.
Pituitary emergencies:
Published in Nadia Barghouthi, Jessica Perini, Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
Jessica Perini, Nadia Barghouthi, Gayatri Jaiswal
Pituitary apoplexy can present with severe, sudden headache, vision changes, lethargy, nausea, and vomiting. Both Sheehan’s syndrome and pituitary apoplexy can present with symptoms of adrenal insufficiency and inability to lactate.
Paper 2
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
A 36 year old woman presents with sudden onset headache and visual disturbance. On examination she is found to have bilateral homonymous hemianopia and left third cranial nerve palsy. A diagnosis of pituitary apoplexy is suspected.
Subclinical hemorrhagic nonfunctionning pituitary adenoma: pituitary gland function status, endoscopic endonasal transsphenoidal surgery, and outcomes
Published in British Journal of Neurosurgery, 2023
Ming Wang, Yugang Jiang, Yang Cai, Huixuan Wu, Yong Peng
Pituitary apoplexy (PA) is a relatively uncommon clinical syndrome characterized by sudden severe headache, nausea and vomiting, visual deficits, ophthalmoplegia, disturbance of consciousness, and hormonal dysfunction1–3. The cause of PA is usually the result of rapid mass effect from an associated hemorrhagic and/or infarcted adenoma4–6. Classical PA is seldom seen, constituting 0.6 to 9% of all pituitary neoplasms3,7. However, hemorrhage within a pituitary tumor without symptoms of apoplexy is frequently observed in magnetic resonance imaging (MRI) studies or intraoperatively, which has been reported in 14% to 25% of pituitary adenomas2,3,8,9. This radiological but clinically asymptomatic hemorrhage into pituitary adenoma has been referred to ‘subacute’ or ‘subclinical’ hemorrhage, implying the absence of symptoms referable to the apoplexy event10–12.
Pituitary apoplexy: how to define safe boundaries of conservative management? Early and long-term outcomes from a single UK tertiary neurosurgical unit
Published in British Journal of Neurosurgery, 2021
Andrea Cavalli, Andrew Martin, Daniel JA Connolly, Showkat Mirza, Saurabh Sinha
Pituitary apoplexy is a complex and life-threatening condition that requires multidisciplinary management. Emergency surgery, within 7 days, is associated with better visual outcomes but complete resolution of even severe visual deficits is possible with both surgical and conservative management. In many cases, visual function recovers within 3 months from apoplexy but further improvement and complete recovery is possible until several years later. Endocrine outcome is poor regardless of treatment strategy. About 48–72 h of initial neuro-observations are generally enough to stabilize the patient and assess the trend of visual deficits. Decision-making process should be tailored to every single patient. Conservative management should be considered in patients with less severe or improving visual impairment. Younger age and smaller tumour correlate with better visual outcomes. We believe that a tumour vertical diameter > 35 mm should tip the balance in favour of surgical management in presence of visual deficit.
Neuro-Ophthalmic Literature Review
Published in Neuro-Ophthalmology, 2021
David A. Bellows, Noel C.Y. Chan, John J. Chen, Hui-Chen Cheng, Jenny A. Nij Bijvank, Michael S. Vaphiades, Konrad P. Weber, Sui H. Wong, Xiaojun Zhang
The authors identified 64 patients with pituitary apoplexy, 47 (73.4%) underwent intended conservative management, while 17 (26.6%) had early surgery. Tumour volumes were greater in the early surgical cohort. Among those with visual acuity and field deficits, visual outcomes were similar between both groups. Conservative management failed in 7 patients (14.9%) and required surgery. Younger age, female sex, and patients with field deficits or chiasmal compression were more likely to experience unsuccessful conservative management. The authors concluded that the majority of patients with pituitary apoplexy can be successfully managed without surgical intervention assuming close neurosurgical, radiological, and ophthalmological follow-up is available.